Endocrine Flashcards by Scott Griffiths

GLP-1 stimulated by

oral glucose load

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GLP-1 secreted by

small intestine L cells

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What is the Incretin Effect?

a higher insulin spike is seen with oral glucose than IV glucose
Mediated by GLP-1, decreased in T2DM

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example of a GLP-1 mimetic

exenetide
s/c injection 60mins before morning and evening meals
can be combined with metformin/sulphonylurea

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When should exenatide be started?

when insulin would be started
obesity a problem (BMI >35)
continue if beneficial (decrease HbA1c and weight loss)

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Risks of exenatide

SE nausea and vomiting

risk of pancreatitis and renal impairment

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example of Dipeptidyl peptidase-4 (DPP-4) inhibitors

sitagliptin,

Vildagliptin

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act of DPP-4i

DPP-4 inactivates GLP-1, therefore potentiating the effect of GLP-1 (increase insulin release, inhibit glucagon)

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do DPP-4’s cause weight gain?

no evidence of increased hypoglycaemias

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another name for subacute thyroiditis

De Quervain’s

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cause of subacute thyroiditis

ususally following a viral infection

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Mx of subacute thyroiditis

usually self limiting
NSAIDs
may need steroids, particularly if hypothyroidism develops.

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Organs affected in Multiple endocrine neoplasia type 1

Parathyroid (95%) - hypercalcaemia
Pituitary (70%) - most commonly prolactinoma
Pancreas (50%) - most commonly insulinoma

From the MEN1 gene

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how is an insulinoma diagnosed

what is the management

supervised prolonged fasting +/- CT

Mx: surgery or diazoxide/somatostatin if unfit for surg.

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Mx of diabetic neuropathy

1st: duloxetine (SNRI), amitriptyline, pregabalin, gabapentin
2: tramadol for rescue therapy
topical capsaicin may be used for localised neuropathic pain

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Haemochromatosis:
inheritance
pathology
features

auto rec
iron accumulation
bronzing of skin, ED, tired, arthralgia (esp hands)
chronic liver disease (and cirrhosis)
DM
cardiac failure (2ndary to dilated cardiomyopathy)
hypogonadism (2ndary to cirrhosis and pituitary dysfunction)

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action of pioglitazone

PPAR gamma receptor agonist

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SEs of pioglitazone

weight gain
fluid retention - C/I in HF
liver impairment - monitor LFTs
increased risk of bladder ca
increased risk of fractures

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causes of low potassium with a raised BP

things affecting RAS system:
Cushing's (and metabolic alkalosis)
Conn's (primary hyperaldosteronism)
Liddle's (increased renin)
11 beta hydroxylase deficiency
liquorice

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causes of low potassium with normal BP

diuretics
RTA (type 1 (distal) and 2 (proximal))
GI loss (d&v)
Bartter’s (genetic defect in loop of henle - like diuretics)
Gitelman’s (same as above but less severe)

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Causes of hirsutism

PCOS (most common)
cushing's syn
obesity (peripheral conversion of oestrogen to androgens)
androgen secreting tumour
adrenal tumour
CAH
drugs: phenytoin

Mx of hirsutism

weight loss if obese

COCP

Ix for acromegaly

oral glucose tolerance test with GH measurements

normally GH is suppressed by hyperglycaemia

screening for gestational diabetes

previous gestational DM: OGTT 16-18w, and at 28w if 1st was normal
other RFs: test at 24-28w

Mx of pre-existing diabetes in pregnancy

lose weight if BMI >27 stop oral hypoglycaemics apart from metformin and start insulin folic acid 5mg OD until 12/40

Mx of gestational DM

responds to diet and exercise in 80% of women if poor glucose control or complications (macrosomia) ; metformin or glibenclamide (sulfonylurea) or insulin stop hypoglycaemics post delivery, OGTT 6weeks postpartum

C/I for radioiodine in Graves

pregnancy (and should be avoided 4-6/12 post Rx) <16 yrs thyroid eye disease (relative C/I)

conditions that can give higher than expected HbA1c levels

increased RBC lifespan: B12/folate deficiency iron deficiency splenectomy

most common cause of primary hyperparathyroidism

solitary adenoma (80%)

classical features of primary hyperparathyroidism

elderly female with unquenchable thirst and inappropriately normal/raised PTH raised calcium, low phosphate

indications for orlistat | what is the target weight loss

BMI >28 with RFs BMI >30 with no RFs aiming for >5% weight loss at 3 months.

Causes of hypercholesterolaemia rather than hypertriglyceridaemia

nephrotic syn cholestasis hypothyroidism

Diagnostic features of metabolic syndrome

``` >3 of: increased waist circumference (central obesity) increased TG reduced HDL HTN raised fasting glucose/T2DM ```

associated features of metabolic syndrome

PCOS non-alcoholic fatty liver disease raised uric acid levels.

What is the risk of thyroid eye disease in Graves' disease?

25-50% Increased risk in smokers Radio iodine may worsen eye disease

What are the criteria for familial hypercholesterolaemia Dx?

LDL >4.9 TC > 7.5 +/-Tendon xanthoma, FHx Heterozygous disease, if homozygous most die before 10 of MI

What is the inheritance of familial hypercholesterolaemia?

Auto dom

Mx of hyperthyroid pt during pregnancy

Propylthiouracil - safe in pregnancy | Aim to keep free T4 levels in upper 2/3rds of normal to avoid foetal hypothyroidism

Diagnostic criteria for DKA

BM >11 Ketonaemia >3mmol/l pH <7.3

Mx of DKA

ABCDE IV fluids - usually need 5-8 litres Insulin infusion - initially 0.1U/kg/hr Replace potassium in second bag

features of autoimmune polyendocrinopathy type 1?

type 1: rare auto rec AIRE1 gene defect oral candidiasis, Addisons, hypoparathyroidism

features of autoimmune polyendocrinopathy type 2? | other name?

Schmidt's syndrome Addison's disease plus T1DM or autoimmune thyroid more common than type 1 10% of Addison's disease patients have other endocrinopathies

mechanism of action of pegvisomant? | uses

GHr antagonist, once daily SC injection used in acromegaly if not surgically fit. decreases IGF-1 to normal in 90% of patients doesn't reduce tumour size

Multiple endocrine neoplasia type 2 features | gene

2a: medullary cancer, parathyroid, phaeochromocytoma 2b: medullary cancer, phaeochromocytoma. Marfanoid body RET oncogene

Repaglinide/nateglinide mechanism of action uses SEs

ATP dependent K channel activators on pancreatic beta cells -> increase insulin release used for patients not controlled on metformin with eratic lifestyles hypoglycaemias (not as bad as sulphonylurea (gliclazide)), weight gain

Ix for MTC

pentagastrin stimulation test | gastrin normally leads to calcitonin release, in MTC there is a marked elevation in calcitonin

Features of carcinoid syndrome | which hormones released?

carcinoid tumours release serotonin and kallikrein Flushing diarrhoea n&v bronchoconstriction - histamine induced 2ndary restrictive cardiomyopathy - serotonin induced valvular fibrosis (mainly R heart)

Ix and Mx of carcinoid syndrome

24 urine 5-HIAA (breakdown product of serotonin) octreotide scan may clarify distribution of the disease. Mx: somatostatin analogues (octreotide) for symptomatic control +/- surgery

Biochemical changes in congenital adrenal hyperplasia

Low-normal cortisol Markedly raised 17-hydroxyprogesterone Due to 21-hydroxylase deficiency in steroid synthesis pathway -> decreased cortisol produced -> increased ACTH as decreased NF

Features of a glucagonoma

diabetes mellitus weight loss diarrhoea necrolytic migratory erythema (red blistering rash of the groin buttocks and perineum)